Home HPV test may help detect early cervical cancer

BOSTON — Home tests for the human papillomavirus (HPV) may help detect cervical cancer in women who would not otherwise be screened by a doctor, a new study suggests.

In the study, researchers mailed home HPV test kits to 155 women ages 30 to 64 in North Carolina. The women had low incomes or were uninsured, and had not had a pap smear in at least four years. (Pap smears are recommended every three years as a way to screen for cervical cancer, which can be caused by HPV.)

About 12 percent of women were infected with high-risk HPV types that increase the risk of cervical cancer, said study researcher Andrea Des Marais, of the University of North Carolina Gillings School of Global Public Health, who presented the findings this week here at the annual meeting of the American Public Health Association.

The women also underwent testing by doctors, to determine whether the home tests had missed cases of HPV, and to look for signs of cervical cancer. (HPV tests cannot directly detect cervical cancer). The researchers found that 3 percent of women had precancerous lesions that could lead to cervical cancer, and that all of these women with pre-cancerous lesions were identified by the home tests as having high-risk HPV.

Women generally found the home test acceptable: 97 percent said they felt positive or neutral about self-collection.

HPV home testing appears promising as a method to screen for high-risk HPV infections in women who don't visit the doctor for screening, Des Marais said. However, future studies are needed to confirm the findings and to compare home HPV testing with other methods for encouraging unscreened women to get tested, such as giving them a reminder phone call, she said.

Home HPV testing is not recommended for women who already get regular pap smears. That's because home HPV testing is not quite as good at identifying high-risk HPV infections as tests conducted at a doctor's office, according to previous research. In addition, many women who test positive for HPV will not have cervical cancer or precancer, so it's recommended that HPV tests be performed in conjunction with a pap test.

"We don't want women replacing in-clinic screening with home testing," Des Marais said. "The idea is, we're trying to reach women who aren’t going to the clinic and then bring them in," to the health care system, she said.

The rate of precancerous lesions among study participants (3 percent) is much higher than the rate among regularly screened women, which is less than 1 percent, Des Marais said.

To perform the home HPV test, women used a brush to collect samples of cells from the vagina and edge of the cervix. They then placed the brush in a preservation solution and mailed the sample to the researchers for testing.

If the findings are validated by future studies, doctors may try to work through large health care organizations, such as Medicaid and the U.S. Department of Veterans Affairs, to identify women who are not up to date with their screening, and mail them home HPV test kits, Des Marais said. Doctors might also go to popular stores, such as Walmart, to find women who don't go to the doctor, and give them self-collection kits.

"Let's take the clinic to the people," said Richard Crosby, a professor at the University of Kentucky College of Public Health, who is doing exactly this type of outreach for a study on HPV testing in rural women.